Cortisol

[Janeylou69]

Hi im hypothyroid and I've just had my cortisol bloods done ,I had them done about 9 :35 in the morning and they were 273 ,is this level cause for concern ,coz now my doctor wants to see me face to face and maybe repeat test ,I am worried coz I feel awful and drained and weak and depressed because of all this thanks for any info .

[Delgor]

As nobody else has answered as yet Janeylou I'm just stepping in to tell you that I was blood tested and was thought to be borderline low but when the endocrinologist found out that the test took place at around 9.20 am he asked for it to be repeated again but I had to make sure it was done by 9.00 am without fail. I have learnt since then that a blood test isn't thought to be conclusive of what is actually happening in the body and a 4 point saliva test with a private company such as Regenerous is often advised which unfortunately I couldn't do because of lack of saliva. I'm sure there are others who could help you better on this subject but hope this helps in the meantime.

[humanbean in reply to Delgor]

GPs think that 9am blood tests (for cortisol) are all they need to do. But patients have found that they get far more information from saliva tests.

Oddly enough, the NHS sometimes does a saliva test for cortisol at midnight or thereabouts, when testing a patient for Cushing's Disease or Cushing's Syndrome. I've also read of some doctors using 24 hour urine tests.

nhs.uk/conditions/cushings-...

[Delgor in reply to humanbean]

Oh thanks humanbean - I didn't realise there were other tests that could be done so will definitely look into this. The list of private tests is becoming longer and longer but it seems to be the only way forward now - aah!

[humanbean in reply to Delgor]

Do you have the reference range for the 273 result you got?

It seems low to me but without the reference range it is really impossible to be certain. Note that when testing cortisol in blood there are usually 2 or 3 reference ranges supplied and the one you compare your result to is the one for the time of day that the blood sample was taken.

Since it appears to be low there is no point in doing a midnight cortisol saliva test. That is for people who are suspected of having really high cortisol, and I don't think any of the private testing companies do such a thing.

The 24 hour urine test for cortisol is not something I would ever do myself. It will tell you how much cortisol you produce in a day, and it might be helpful, but it won't tell you any more than that.

The four-part saliva test tells you the amount of cortisol you have at different times of day. It won't necessarily give you the same answer as the blood test. One of them could be high while the other is low. That in itself is an interesting piece of information when trying to improve cortisol issues. DHEA will give you some helpful information as well - often if it is low it will tell you that your cortisol is likely going to get worse!

[Delgor in reply to humanbean]

I think this was meant for Janeylou and I have no idea how to redirect it as I'm not at all techi but I'm sure you will know🙃

[humanbean in reply to Delgor]

Oops! I'll mention Janeylou69 to catch her attention.

Sorry, I posted my reply to Delgor by mistake.

[Delgor in reply to humanbean]

No worries - It's all information worth reading!

[Janeylou69 in reply to humanbean]

No worries I've read all the information thanks for your help, I really don't know much about cortisol or adrenal glands and I'm worried about what this will mean xx

[Janeylou69 in reply to humanbean]

Hi humanbean, the reference range for the cortisol test I did is 140 - 700 and I done the blood test at 9:35 am so I think it is low ,but I think they want me to repeat it thanks for all your replies x

[humanbean in reply to Janeylou69]

I think that reference range is a random cortisol test range. It is not informative and I would be very upset with a test of that type. I think it is not worth your time or effort, or the money it costs the NHS to carry it out.

Cortisol is produced by the body with a circadian rhythm as shown in the (rather pathetic) picture.

So, a level of cortisol of 600 might be okay at 9am but would be horrendous at 9pm.

And a level of 150 might be okay at 9pm but would be dreadful at 9am.

So the reference range you've been given is utterly useless.

Cortisol circadian rhythm

[Janeylou69 in reply to humanbean]

Hi thanks for this information, I'm seeing my doctor next week ,so hopefully we will get somewhere and tell her about my symptoms coz I feel weak tired , muscles feel weird ,I could go asleep anytime in the day and it doesn't really refresh me that's how know something is not right thanks humanbean x

[Bearo in reply to humanbean]

I know nothing about cortisol testing, humanbean, so I bow to your knowledge and understanding but might a single 9am blood test show low cortisol , if that is the problem? So, if it is too low, further tests could be carried out?

[humanbean in reply to Bearo]

A single blood test result which is low at 9am could show low cortisol, but it is also possible for people to have a low result at 9am and then a high result 2, 3 or 4 hours later or whatever. One low result will obviously show there is a problem, but it misses out so much information that it isn't reliable, and it isn't always clear what problem is being shown.

My own circadian rhythm for sleeping is so messed up that I wouldn't have any idea what time my cortisol is at its highest. That is what the 9am blood test is supposed to show. But for people working night shift, or severe insomnia that has lasted months or years, or taking drugs which affect the circadian rhythm, a single blood test result at 9am might not tell such people anything very useful.

If you look at this link :

rt3-adrenals.org/cortisol_t...

Example 1 gives optimal results for saliva testing of cortisol.

But also note that it says above that example :

*Someone who has an unusual sleep schedule for an extended period of months or years may need to use his or her normal wake up time and bedtime for the first and fourth samples. The second sample is then collected four to five hours after the first, and the third sample four to five hours after the second. The standardized times identified in the kit would be disregarded.

Some people could have one of these conditions :

en.wikipedia.org/wiki/Non-2...

en.wikipedia.org/wiki/Delay...

or possibly extreme insomnia. If these things go on long enough then who knows what their 9am cortisol would be and when.

Personally, I would always trust a 4 - part saliva cortisol test over a single blood test - but doctors would no doubt think differently.

...

There was one member of the forum who did a saliva cortisol test who turned out to have Addison's Disease. You might like to see the results she got :

healthunlocked.com/thyroidu...

Be aware that the reference ranges for blood cortisol are completely different to those given for saliva cortisol, and probably have completely different units of measurement too. Blood cortisol and saliva cortisol aren't testing the same thing.

You may be familiar with T4 and T3 being measured as "Total" or "Free" and everyone is told that the most useful tests are the "Free" ones. Free T4 and Free T3 are measures of the biologically active hormones that actually do something.

The same is true of cortisol testing...

Cortisol measured in blood is showing "Total" or "Bound" Cortisol.

Cortisol measured in saliva is showing "Free" or "Unbound" Cortisol.

[Bearo in reply to humanbean]

thanks for the detailed reply - I get it now!

[Janeylou69 in reply to humanbean]

Hi humanbean thanks for your reply ,I know my cortisol was low ,could it be adrenal fatigue ,I'm hoping I haven't got Addisons disease or anything else ,my arms and legs ache so much especially when I use them , I don't feel good at all and the tiredness is the worst I've ever felt .

[humanbean in reply to Janeylou69]

If your cortisol is in range you won't have Addison's Disease even if it is low in range.

You could have adrenal fatigue, but unfortunately doctors "don't believe in it" and just dismiss patients who mention it.

The difference between the two is that Addison's Disease is caused by the complete failure of the adrenal glands and they can't be brought back to life. The only treatment is taking cortisol substitutes for life - there are no alternatives.

Adrenal fatigue is basically a condition in which the adrenal glands are unhealthy but they can be brought back to full health with the right treatment. That involves all the things that get mentioned on the forum...

1) Get thyroid hormones at a good level for you.

2) Improve/optimise diet and nutrition.

3) Take vitamin and mineral supplements if necessary to maintain good levels.

4) The adrenals need salt so don't skimp on it (and don't overdo it either).

5) The adrenals need plenty of vitamin C.

6) Get some gentle exercise, but strenuous exercise isn't a good idea. Don't overdo it.

7) Get enough sleep (the really tough one, from my point of view).

You could read this thread. I dumped just about everything I thought might be helpful on the subject of adrenal health :

healthunlocked.com/thyroidu...

Bear in mind the thread is a couple of years old and some of the links may be broken.

[radd]

Janeylou69,

A 9am cortisol blood test is taken to assess levels at a time when adrenal output should be highest. 

Even without ranges I would suggest your result is low as usually anything > 350 nmol/l is considered good. Your GP is repeating to ensure a correct result and will most likely refer you to an endo for a Stim test where an injection will stimulate the adrenal glands to see if they are capable of a normalised output (I think it’s anything  ≥450 nmol/L). 

The adrenal glands produce our stress hormones and long term inadequate thyroid hormone levels will not only compromise adrenal reserve but can alter our circadian patterns to an extent where we produce most or least at inappropriate times. 

Most members respond positively to a Stim test as their low levels are the result of being compromised by low thyroid hormone and not Addisons. By worrying about your results you will cause further stress to your adrenal glands. 

The medical profession will only be looking for Addisons and as others have said a private saliva stress test which includes both cortisol and DHEA will be far more informative regarding your circadian patterns and how advanced your adrenal fatigue is. 

[Janeylou69 in reply to radd]

Thanks for this information, sounds a bit scary and I try not to worry but it's really hard not to worry ,I feel awful x